MAGA? Don’t you mean MACA?

It was touching, wasn’t it? Literally as well as metaphorically. You know, the joyous handclasps. Holding each other’s hands. All with smiles to underline the intimacy and good fellowship.

The scene was Tianjin in China. Present were the host, Xi Jinping, Chinese leader and the world’s most powerful autocrat. With him was Vladimir Putin, Russian leader and the world’s most brutal autocrat. Joining them was Narendra Modi, Indian leader as Prime Minister of the world’s biggest democracy and its second most powerful would-be autocrat.

Modi’s presence was the most remarkable. Less than three years ago, in December 2022, Chinese and Indian troops were attacking each other with, of all things, nail-studded clubs across their common border. Now, though, it’s all friendship and good cheer between the two nations.

Putin, Modi and Xi Jinping

Best of buddies. All thanks to Trump

In theory, this ought to please the world’s top would-be autocrat. Donald Trump’s always quick to trumpet – Trump-et? – his role as peacemaker. The man who’s going to bring peace to Ukraine or Gaza in a single day hasn’t yet found the right day on which to make that happen. To compensate, he might take some satisfaction from having promoted peace between those two Asian giants.

Sadly, though, it’s not clear to me that he brought them together intentionally. There may be people who regard Trump as a champion of subtle strategic thought. I’m afraid that I’m not one of them. He slapped tariffs of 25% on Indian exports to the US and then, when India persisted in buying Russian oil, doubled them to 50%. That drove Modi towards Xi Jinping, to see whether China could become a sufficiently significant trading partner to make up for some of the lost business with the US.

Was Trump motivated by an altruistic desire to improve Sino-Indian ties even at the cost of US relations with the subcontinent? As I say, some may believe he’s capable of such ingenuity. They may be right, but I can only say that I find it hard to believe.

To be honest, even the pretext for increasing the Indian tariffs is hard to swallow. I mean, Trump is always proclaiming his admiration for Russia and for Putin. I reckon he envies Putin and would like to imitate him in the US. Putin, of course, has no intention of imitating Trump. Still, given Trump’s apparent deference towards Putin – Trump regularly talks tough about his Russian opposite number, but Putin only has to meet him to twist him around his little finger again – it’s odd that Trump reckons his tariffs on India are about Modi buying Russian oil.  

The journalist John Sopel, now co-hosting the podcasts The News Agents and The News Agents USA with Emily Maitlis, has a different explanation of Trump’s behaviour. India and Pakistan had their own border conflict between 7 and 10 May. It involved missile firing and air raids, so it was a tad more serious than the 2022 clash between Indian and Chinese border troops armed with clubs.

The incident eventually ran out of steam, with both sides apparently feeling they’d done enough damage and killed enough people to satisfy that strange beast, national honour. Trump though had rung the two sides and that, he has convinced himself, made him the engineer of peace between the two nations.

Pakistan, apparently keener than India on being obsequious towards Trump, nominated him for the 2026 Nobel Peace Prize. India, instead, argued that peace happened independently of Trump’s minimal efforts. Modi refused to back him for the Peace Prize.

Sopel’s suggestion? The different attitudes of the nations over the Nobel prize cost India its penalising tariffs, far higher than Pakistan’s. It seems hard to credit, doesn’t it? But should anything surprise us anymore when it comes to Trump?

Let’s not stop at India, though. Another nation that has had punitive tariffs inflicted on it is Brazil, the second biggest democracy in the Americas, and the nation that is making its previous would-be autocratic president answer for his illegal attempts to hold onto power. Trump has imposed 50% tariffs on it. Which is curious, since his general justification for tariffs is to hit back at nations with which the Americans are running a trade deficit. That is, nations so devious that they produce goods Americans are keener to buy than their own people are to buy US products.

Curiously, Brazil is one of the minority of nations with which the US has a trade surplus – it sells Brazil more than it buys from it.

Still, it doesn’t take long to find the real reason for the tariffs on Brazil. It’s precisely because it’s holding its ex-President to account. He tried to raise an insurrection to prevent his opponent, who’d beaten him in the election, driving him from office. Having tried the same trick himself, Trump clearly opposes any move to make the author of an attempted coup face retribution for his action. 

Hence the tariffs.

So where is Brazil turning for help? Why, to China.

Funnily enough, South Africa is doing the same. Trump has swallowed the entirely fictitious story of an anti-white genocide in that country (evidence isn’t a Trump requirement for anything he has chosen to believe). Ironically, while Trump is deporting as many migrants from the US as he can, he’s opened the door to one category of refugees – white South Africans. And he’s imposed 50% tariffs on South Africa too, driving them into Chinese arms alongside the others.

The original five members of the group of nations known as the BRICS were Brazil, Russia, India, China and South Africa. Isn’t that curious? Precisely China and the four nations now turning to it for help in the face of Trump’s aggression. What help China can provide is far from certain. But even if the help is limited, the realignment of the nations is clear and no doubt lasting.

In other words, Trump’s actions are powerfully assisting the Chinese playbook for world leadership. And that’s on top of moves to cut investment in such technologies as Electric Vehicles, leaving the field open to China to dominate.

So should MAGA continue to call itself MAGA at all or produce its nice red baseball caps proclaiming that ‘Trump was right about everything’?

Since he’s clearly not making America great again, maybe it’s time to change the movement’s name to MACA. That’s ‘Make America China’s Agent’. The caps could be marked ‘Xi Jinping’s getting it right’. 

At least that would be a lot more accurate.

Governments losing against Coronavirus: it's no coincidence

“One of the things that makes novels less plausible than history, I find,” says a character in Tom Stoppard’s play Night and Day, “is the way they shrink from coincidence.”

We do try to reject coincidence. “This happened after that other thing happened, so it must have been that other thing that caused this one.” Post hoc ergo propter hoc, the Romans used to say, after that so because of that.

And yet there really are things that are simply coincidence, in the sense that they happen together, or after each other, purely by chance.

London had a population climbing towards seven million over the decade I was a student there (yep: I was once the proud owner of ten University of London student cards). And yet I hadn’t been there many years before I had my first experience of meeting people I knew, without arrangement, on the street. It happened to me several times over the period I lived there.

What? The chances of meeting any particular person out of 6.5m is, naturally, 6.5m to 1. And yet I several times met individuals I knew?

We are not intuitively good at handling statistical reasoning, as the psychologist and economist Daniel Kahneman has pointed out. I had a wide network of acquaintance, which immediately increased the chance of meeting any one of them by chance. And it was not as though I only ever crossed the path of one other person in any one day – on the contrary, commuting from home to work or to college brought me close to hundreds or even thousands of people (hence the difficulty of maintaining social distancing today).

Take that into account, and the probability of meeting someone I knew was significantly higher than I might have imagined. Certainly, high enough for it to be perfectly reasonable that it should happen several times over a ten-year period. Particularly when you consider that most frequently the encounters were in places which act like people-funnels, such as the main railway stations.

In fact, the most surprising such event I witnessed was just last year, as I was catching up with a Turkish friend, Muharrem, who was about to enter Victoria Station ahead of me. I found him in lively conversation, in Turkish, with a woman. After she had left, Muharrem explained to me, “she’s one of the most famous novelists in Turkey, and I met her when I was working at a library where she came to give a talk”.

Despite this kind of experience, we do shrink from coincidence. Indeed, that shrinking becomes a weapon in the armoury of people trying to build certain kinds of argument. They might, for instance, say:

“My friend Sally took that medication. And exactly two years, five months and 17 days later, she had a series of terrible migraines. Coincidence? I think not.”

It’s a great debating trick, because it establishes in advance that only the most naïve and credulous people could possibly respond, “well, actually, yes, I reckon it probably is a coincidence.” As, of course, it is.

After all, Sally probably took other things than that medication before getting her migraines. If anything that happened before them could be regarded as a potential cause, might it not have been the chocolate she had the day before, or the overindulgence in wine, or the fact she drove through a polluted neighbourhood? After that so because of that isn’t an argument, it’s a sloppy and unreliable way of reasoning.

To establish that there’s more than chance at play, we have to show some causal connection between the two incidents.

To take a different example, naturally chosen entirely at random, consider lousy government. Faced with a major and fatal pandemic disease, a lousy government fails to take it seriously. It may attempt to put in place measures to protect its healthcare workers, and even promise to do so, and then take far too long and under-deliver. It may, rightly, identify track-and-trace as the best way to combat the virus, promise to put a system in place and then fail to meet its own deadline.

Or lousy government might just be far too glib in attitude. It may be scornful about simple and effective measures like wearing masks. It may pay lip service to other measures, such as social distancing or quarantining, while flouting them itself and turning a blind eye to infringements by friends or supporters. It may be halfhearted about its lockdown measures and end them too soon.

Now which governments around the world have been most guilty of some or all of these kinds of behaviour?

Why, the governments Trump’s United States, Johnson’s UK and Bolsonaro’s Brazil. Which makes it fascinating to look at the latest figures published by Worldometers. Imagine which are the governments with the highest numbers of deaths due to Coronavirus:

The three nations with the worst Coronavirus death totals
Note that Johnson's UK has the worst death rate per million

A coincidence? I think not.

A hard-won government in Spain can teach us a lot

It’s been a long haul, but Spain at last has a confirmed government again.

That matters to me particularly because we now live in Spain, land of our Brexit exile. Others, though, might also find much of relevance in the difficult road that got us here, littered as it was with obstacles, many of them self-inflicted.

Pedro Sánchez addresses the Cortes

Let’s start with the positives.

Spain has its first coalition government since the end of the Franco dictatorship and the restoration of democracy in 1978. That brings it into line with most countries in Europe, where government always requires negotiation between parties and compromise to reach an agreement that commands broad support. It’s not the case in Britain, of course, where Members of Parliament are still elected by simple majorities in individual constituencies. As a result, parties with minority support nationally can command a huge majority in Parliament. As is the case today.

I’m not sure that this leads to better government.

Pedro Sánchez, now the confirmed Prime Minister of Spain after holding the role in an acting capacity since last April, and leader of the centre-left Spanish Socialist Workers’ Party (PSOE), has agreed a joint programme for progressive government with Pablo Iglesias, of the anti-austerity, harder-left Unidas Podemos Party (UP). That has kept the right well away from power, even though the far-right Vox now has a major parliamentary presence.

You read that right. A joint programme for progressive government. And the hard right out of power.

How many, in Britain, the United States, Poland, Hungary, Turkey or Brazil would give their eye teeth to have such a government? And how many, particularly in Britain, the United States, Poland, Turkey or Brazil would like to see the far right well away from government?

So, now the negatives. 

The Spanish left nearly didn’t pull the trick off, and its worst enemy was itself. As in Britain and the United States especially.

That joint programme between PSOE and UP was something that could have been agreed months ago. Say, straight after the General Election in April, which left the PSOE as the biggest single party in the Spanish Parliament – the Cortes – with 123 seats, while UP had 42. PSOE was up significantly, while UP had lost seats, but at least between them, they had 165 MPs, just 11 short of the 176 needed for a majority in the 350-seat Cortes.

They couldn’t reach agreement. After six months of negotiation, new elections had to be called in November. Both parties lost seats, three in the case of the PSOE, though it was still the biggest party in Parliament, while UP lost seven. Now their task had become far harder, since they’re now 21 behind the magic number for a majority.

Far worse still was the surge in support for the quasi-fascist Vox, which shot up from 24 to 52 seats to become the third biggest parliamentary presence.

The PSOE-UP failure to compromise before the November election meant that when they finally did, the two parties of the left were working from a weaker position, and against a far more vigorous opposition. Note and learn, British Labourites or American Democrats: you risk it all when you decide to dig your heels in and refuse to budge on principle. Insisting on doing it all may leave you unable to do anything at all. The price of intransigence can be a Trump or Boris government.

Sánchez has at least avoided that fate, but by the tightest of margins. He couldn’t win his investiture on Sunday (yes, Spanish MPs can work on Sundays) when an absolute majority was required, in the first vote; on Tuesday however, with the bar lowered to requiring simply more Yes votes than Noes, he squeaked through, by just two votes with eighteen abstentions.

Those abstentions were won through hard negotiation. Sánchez had to make agreements with eight parties, covering 313 different commitments, to secure those abstaining votes. Not all those commitments are compatible with each other. Government, with so much to deliver to keep minor parties at least neutral, and up against such a powerful right, isn’t going to be easy.

This is particularly true in the specific circumstances of Spain. Some of the commitments Sánchez has had to make concern the status of Catalonia and its desire for independence. That’s something he can’t grant and retain his support in the rest of Spain; it’s going to be challenging to give the Catalans enough, short of independence, to keep Tuesday’s abstainers in line.

With a powerful and ferocious right-wing Opposition, he and Iglesias are going to have torrid time implementing their programme. It’s going to be enthralling to watch. I’m at least glad they have the opportunity to try – after the crushing defeat of the British left in December, being able to do as much as Sánchez can in Spain seems a distant dream.

There were some good moments in the investiture debate.

One of the most moving was the standing ovation offered to Aina Vidal, who turned up to vote despite undergoing aggressive treatment for cancer.

Aina Vidal stands to acknowledge the ovation for her presence

Another was Sánchez’s reference to one of the iconic figures of the Second Spanish Republic, the one overthrown by Franco. Manuel Azaña told his compatriots, “we are all children of the same sun and tributaries of the same river”.

In Britain and the US, I can’t help feeling that we’re all children of the same deeply disrupted climate system, and tributaries to the same traffic jams.

Maybe the Spanish example can help us towards a more encouraging future.

Avoiding the avoidable: the problem of delayed discharges

So far I’ve mostly talked about avoiding the avoidable in hospital expense only at the start, the admission stage, of a hospital stay. But the problem arises at the other end too, when a patient has to stay on because the discharge process is delayed. 

There are two main reasons why this might happen.

OK, so why can’t I just go home?

The more obvious one is that the discharge has not been properly prepared. Tests need to be carried out to confirm that the patient is fit to go home, but the results haven’t been received – or perhaps the tests haven’t even been ordered. Possibly the patient needs to take medications home and the necessary prescription hasn’t been sent through to the hospital pharmacy. Or, even more simply, the discharge needs the approval of a doctor who simply isn’t available, called away to an urgent conference which perhaps, and entirely coincidentally, is taking place next door to a prestigious golf course.

This kind of problem occurs everywhere. Recently I read a 2014 study of two hospitals in Brazil. It found that in one of the hospitals, delayed discharged represented a 23% extra occupancy rate, a figure that climbed to 28% in the other. That means a massive proportion, around a quarter, of the beds in those hospitals were occupied at any one time by people who should already have left.

The other main reason for a delayed discharge is particularly familiar in a nation such as England. Patients can’t leave because there’s nowhere for them to go where they will receive the ongoing care they need. This is particularly acute for older people who may be living alone with no one available to act as carer. They can only be discharged once there is a social worker or community nurse available to help them, or perhaps a bed in a care home.

Delayed discharges generate two problems. First of all, it’s bad for the patients: people generally recover better in their own beds than in hospital and, in any case, simply by staying on patients are exposing themselves to unnecessary risk, if only of infection from other patients around them.

Secondly, the delayed discharge is bad news financially. Acute hospital care is the most expensive care and, even though costs will be lower towards the end of a stay by which time the patient requires less treatment, the mere fact of occupying a bed is expensive. That’s without taking account of the impact on other patients who might have benefited from being admitted to a bed blocked in this way.

A recent study (February 2016) for the NHS in England by a team headed by Lord Carter of Coles, Operational productivity and performance in English NHS acute hospitals: Unwarranted variations, put a figure on the impact of delaying discharges: “the cost of these delays to NHS providers could be around £900m per year.”

That’s close to 2% of the total expenditure on acute care.

How do we fix these problems?

Both require management action, naturally. For instance, my wife worked until two or three years ago in the Discharge Planning team of our local hospital. Here, nurses, social workers and hospital staff worked out of a single suite of offices, preparing the plan to discharge a patient from the moment he or she was admitted. That meant that the agencies involved in post-hospital care had the greatest possible notice that their services would be needed. They could, therefore, assign staff or find suitable accommodation, at least as far resources allowed, in the most favourable possible conditions, rather than in a rush at the end.

Equally, steps can be taken in plenty of time to ensure that all necessary processes are carried out, the appropriate tests or medications ordered, and the paperwork prepared for someone to sign who will be around at the right time.

Computer systems can help, of course. The kind of pathways management software I’ve been talking about in this series can be used by hospital staff as it can by people in primary care. It can issue alerts not just to physicians but to nurses and care assistants: “for this patient to be discharged tomorrow morning, you have to request this test today,” for instance.

When it comes to helping with groups like my wife’s former colleagues, what’s needed is ways to improve collaborative working between different systems. Social work management software needs to interwork with nurse management and general hospital systems. Fortunately, none of that is impossible and over the last few years, great strides have been taken towards making it happen.

What that means is that avoiding the avoidable can now be tackled at both ends of a hospital stay: discharge, with its own specific problems, as well as admission.

True commitment: football the Shankly way. Or Brazil's.

‘Some people believe football is a matter of life and death, I am very disappointed with that attitude. I can assure you it is much, much more important than that,’ said Bill Shankly, legendary manager of Liverpool Football Club.

Bill Shankly, football legend and model of commitment

England has won the Football World Cup just once. Brazil has won it five times. That record suggests the Latin Americans have a different mindset from ours, one that corresponds rather more closely to Shankly’s. One can be forgiven for thinking they display a level of commitment usually reserved for world religions, major political movements or making large amounts of money (or are all those the same thing?)

Recent events shown the Brazilians are capable of all of that and then some.

I’ve heard of referees who take a dim view of the behaviour of certain players, and penalise them harshly in consequence. But stabbing them? Fatally, to boot? That’s really impressive.

Equally, I know that it’s easy for spectators to lose their rag with referees, demanding their expulsion (or at least that they visit the opticians). Another legendary manager, Alex Ferguson, who stood down at the end of last season from over a quarter of a century in charge at Manchester United, famously denounced refs in lurid terms on numerous occasions and was disciplined more than once in consequence.

Decapitating the ref, however, as happened to the unfortunate who stabbed the recalcitrant player? Generally, in England we like to reserve our mob decapitations for kings.

Brazil: serious enough about football even for Shankly

But, hey, the Brazilians have true commitment. The kind that makes you realise that Shankly was literally right and football is much more serious than mere life and death. Which, in this case at least, truly made it a matter of life and death. 

The results speak for themselves. Five world cups. To our one.

Submerged by the Brazilian surge

There was some shock in Britain this week at the discovery that the UK had been knocked off its position as sixth largest economy in the world to be overtaken – oh, indignity – by modest little Brazil. Modest and little because it has a population of only 190 million compared to our mighty 62 million, making Brazil barely three times bigger.

Well, OK, just over three times bigger.

I’m not quite sure what losing sixth slot means. We don’t make the cut? We don’t get to play in the final? That can’t be right. If you listen to the doom and gloom merchants, the final is already under way, and not the final match but the final act, and we’re all in it.

What I don’t understand is why it was such a big deal that most of the papers carried the story, as did the BBC. Surely if it's interesting at all, it’s a matter for congratulation, isn’t it? For far too long Brazil was struggling with poverty, crime and vile military regimes. They’ve apparently successfully put the military back into its box. Crime seems pretty much as endemic as ever. If they’ve started to make some inroads on poverty, well that has to be good news on two fronts out of three, and not something we should be getting upset about.

If anything, a bit more of the same would be good. Leaving to one side the issue of how much growth a resource-constrained world can stand, a bit more GDP per head would be good: in Brazil, it’s still about a third of Britain’s. So great that they’re doing better than they were, but a bit more of the same might be no bad thing.

As it happens, the people who brought us the news about Brazil’s move into sixth place do reckon they will keep doing better. Here’s the league table they produced:

  Source: ECBR

Now that table is just brilliant, in so many ways. Look at Germany dropping like a stone, leaving it hovering only just ahead of the UK; France even falls behind us.

And look at Russia and India just powering up the rankings. Heady stuff.

But that’s not what I mean about the table being brilliant. The brilliant bit is the stuff around it. Let’s start with the word ‘forecast’, on the column for 2020. Did they imagine that without it we would believe that they’d built a time machine, travelled to some time after 2020 to take a look at the state of the world, and then had the goodness to travel back and tell us what they had found out, not as a forecast but as a matter of historical record? 

Even more important is the source of the information. The ‘CEBR’ is the Centre for Economic and Business Research. That casts the notion of ‘forecast’ in a completely new light.

A Centre for Research of any kind just demands your respect, doesn’t it? 
If I pop down to the pub with four or five mates and we talk about the dire state of the world, that’s just whinging over a drink. But if we raise some money and take an office in a prestigious location and stick a brass plaque on the door with ‘Centre for Research’ on it, we become a reputable authority deserving to be taken seriously. Even if round the meeting table it’s the same five guys, with the same beer and the same brand of crisps.

Things are pretty much the same in those great centres of contemporary power, such as rating agencies. As I’ve said before, they’re seen as forces of nature expressing the will of God, or perhaps the will of the Market, insofar as they make any distinction between God and the Market, but in fact they’re just twelve guys sat around a table condemning Greece or Italy or anyone else that attracts their ire, to several more years misery.

Of course, you can't really compare these people with my five mates. These are experts in economics or business. Which makes them special. And I really mean special: economics and business experts are the only people who prevent weather forecasters being at the bottom of the mockery pile. Which presumably making them fundamental to the forecasting profession. If only in the sense that the fundament is the bit we all sit on.

Here’s a little illustration.This is the Guardian on 27 December talking about the Italian plan to sell more bonds in an auction over the following two days: ‘In an indication that traders fear the auction could prove expensive for Italy, the indebted country saw its 10-year cost of borrowing rise by about 11 basis points to 7.13%, before settling back below the psychologically important 7%.’

The following day, when things turned out rather better than expected in the first phase of the bond sale, the Guardian blog ran with the headline ‘Successful Italian bond sale cuts its borrowing costs’.

Then on the 29th, after the second auction didn’t raise quite as much as the maximum hoped for, the paper gave us ‘full details of today's Italian debt sale’ and commented ‘analysts aren't impressed.’

Yeah, right. Would these be the same analysts who were so concerned about Italian debt on Tuesday, reassured on Wednesday, now reverting to pessimistic type on Thursday?

Personally, I’ll reserve my admiration for economists until they get that time machine built.

In the meantime, all I can say is – ‘good on you, Brazilians. Doing well. Keep it up.’